PROJECT SUMMARY Despite more than 50 years of research on the topic, poor communication between physicians and nurses re- mains a pressing problem, contributing to ongoing and widespread barriers to patient safety. The purpose of this study, using a mixed-method design, is to determine if a videotape-based method can feasibly capture communication events, and help us define mutual understanding. Good communication is defined as mutual understanding between communicators which is important because each group (i.e., physician, nurse) must convey information in a way that the other will understand. Videotaping will capture and record behaviors and relationships, often cited as characteristics that affect communication, but that otherwise are difficult to capture. During video review physicians and nurses will focus on specific details of their communication practices, re- vealing their habits and gaps between what they say they do and what is actually done, providing the starting point to explore mutual understanding. Specific Aims: We seek to: (1) determine the feasibility of using vide- otaping as a method to fully capture communication events between physicians and nurses in an inpatient set- ting; and (2) determine if videotape review by physicians and nurses can be used to define mutual understand- ing based on multiple perspectives. Design and Methods: The study will use a mixed method design. We will randomly select two medical-surgical units in a large academic medical center, one unit staffed by hospitalist physicians and one staffed by teaching services. We will shadow and videotape up to 10 nurses and 10 physi- cians on each unit. Each videotape will be spliced into separate conversations between a physician and a nurse; individual copies will be given to nurse and physician subjects who will add comments on the tape at junctures where they believe mutual understanding did or did not occur. Using descriptive statistics we will make broad comparisons between physicians and nurses. The physician, nurse, and researcher will jointly re- view the tapes during audio-recorded interview sessions. Qualitatively we will develop themes describing top- ics being discussed when tapes were paused, use inserted comments to determine why tapes were paused, and determine how joint review of the videotape possibly changed communication practices and influenced mutual understanding. Significance: The value of directly recording physician-nurse interactions is that it pro- vides real-time performance data for researchers to analyze and use to design effective interventions. Joint review of videotapes will allow us to uncover possible solutions to the problem of poor communication, which were previously inaccessible because of the methods that were used. Most importantly, this study will provide insight into how miscommunication occurs and possible ways to improve communication practices, with the ultimate goal of providing safer care for hospitalized patients. 1